Cerebral candidiasis in two premature infants, severely handicapped on follow-up at 3 and 6 years, is reported from the Women’s College Hospital, Toronto, Canada. Infant 1 had respiratory distress syndrome and was treated with ampicillin and gentamicin for 5 days. A Candida diaper rash with skin breakdown on day 12 was complicated by sepsis, treated with vancomycin and cefotaxime, and followed by systemic candidiasis, requiring amphotericin and 5-flucytosine. Head ultrasound showed echogenic fungal microabscesses in brain parenchyma that resolved after 37 days treatment. Follow-up at 6 years revealed mild cerebral palsy, severe aphasia, and ADHD. Infant 2 had respiratory distress syndrome, low Apgars, skin rash, sepsis treated with ampicillin, vancomycin and gentamicin, and at 6 days, candidiasis treated with amphotericin and flucytosine. Head ultrasound showed scattered echogenic microabscesses, and later, calcifications in the basal ganglia and periventricular areas. At 3 year follow-up, the child had spastic quadriplegia, speech impairment, and cognitive delay. [1]

COMMENT. Previous reports of candidiasis involving the brain have involved autopsy descriptions of scattered microabscesses. Large doses of amphotericin (1 mg/kg/d) and 5-flucytosine were thought to explain the survival of the two infants described above, although the resolution of infection did not prevent significant neurologic handicaps as sequelae. Treatment was continued for 37 days in case 1, with the better outcome, and 22 days in case 2, more severely handicapped. Perhaps more prolonged treatment may have improved the outcome, but serious side effects can be a problem. AAP 1997 Redbook recommends 6 weeks or longer treatment for systemic candidiasis in high risk patients.